Breast Cancer Treatment Options Every Woman Should Know

Breast cancer treatment involves many pathways, with many treatment options available for the disease's different stages and forms. Understanding all of these treatment options is a powerful tool in fighting breast cancer and feeling more in control of your health. Read on to learn about breast cancer treatment options, and share this article with people in your life who have been affected by breast cancer!

The Stages of Breast Cancer

The stage of any breast cancer is a major part of determining the right treatment path. The extent to which a breast cancer has developed is more than just the size of a tumor or how much it has spread, and breast cancer staging guidelines have actually been updated and deepened in the past year. Staging guidelines now also include:

• ER-positivity: if the cancer cells contain hormone receptors.
• HER2-positivity: if the cancer cells contain large amounts of the HER2 protein.
• Menopause
• Overall health and lifestyle
• Cancer growth rate

Each stage has specific signs that help identification:

Stage 0: A non-invasive cancer; limited to the milk duct.

Stage I: Relatively small area of cancer. Has either not spread to the lymph nodes, or only spread to the likeliest one, the sentinel lymph node.

Stage II: Somewhat larger cancers; may have spread to a few other lymph nodes.

Stage III: Larger tumors, possibly growing into nearby tissue, such as the skin over the breast or muscle underneath. May have spread to many lymph nodes.

Stage IV (Metastatic Breast Cancer): Has spread to other areas of the body beyond the breast or nearby lymph nodes.

Other Types of Breast Cancer

Not all breast cancers follow the same path or properties. These cancers have different signs.

• Inflammatory Breast Cancer: A rare, aggressive form of Stage III or IV breast cancer that blocks lymph vessels in the skin over the breast, leading to a swollen or inflamed look.
• Recurrent Breast Cancer: Cancer that returns after treatment, which can be local, regional, or distant.
• Triple-Negative Breast Cancer: An aggressive breast cancer whose cells don't have estrogen or progesterone receptors, and have a limited amount of the HER2 protein, making some common treatment options unsuitable.

Local Treatments

Local treatments work to treat the tumor and surrounding area without affecting the rest of the body. This is the primary form of treatment in earlier stage cancers, but may be combined with farther-reaching therapies.

Surgery

Breast surgery is a common aspect of breast cancer treatment, and it can be done to remove or treat the cancer, investigate its spread, or even restore the shape of the breast. The most common surgeries are:

• Breast-Conserving Surgery (BCS): Also called a lumpectomy, in which the cancerous part of the breast and possibly some surrounding tissue are removed.
• Masectomy: The removal of the entire breast, including all breast tissue and possibly some surrounding tissue. A double masectomy involves the removal of both breasts.

The decision between these two surgeries is largely dependent on the size and location of the tumor, although breast-conserving surgery is often accompanied by treatments like radiation. There is no marked difference in survival rates between the options.

Other surgeries include:

• Lymph Node Surgeries: Sentinel lymph node biopsy (SLNB), in which the nearby sentinel lymph node under the closest is removed, and axillary lymph node dissection (ALND), in which many lymph nodes under the arm are removed. These surgeries are done to both investigate and remove the spread of the cancer.
• Prophylactic Mastectomy or Ovary Removal: A preventative measure, this is when the breast or ovaries are removed from a woman at high risk of cancer. Removing the ovaries lowers the body's estrogen levels, which reduces cancer risk.
• Breast Reconstruction: Surgery to restore the breast shape following a breast-conserving surgery or mastectomy. This can be done with breast implants or by flap procedures, which use skin, fat, and even muscle from other parts of your body.
• Advanced Breast Cancer Surgery: Surgery can be used to alleviate symptoms of breast cancers that have spread, such as pain, blockages, or swelling, or to slow further spread.

Radiation Therapy

Treatment with high-energy rays or particles, this is often combined with other treatments to destroy cancer cells that have spread or to prevent cancer from recurring after a surgery. There are two types:

• External Beam Radiation: The use of a high-energy ray aimed externally from a machine to destroy cancer cells, this is often used following a mastectomy on tissue surrounding the removed breast, or after a BCS on the whole breast with extra focus on the tumor bed, the area where the cancer was removed. It is also used on lymph nodes if the cancer has spread to them.
• Internal Radiation: Also known as brachytherapy, this is when a catheter or other device is placed in the breast where cancerous tissue has been removed. Radioactive pellets or seeds are placed in these devices for short periods at scheduled intervals.

Systemic Treatments

Drugs that attack the spread of cancer throughout the whole body are considered systemic. These are usually the primary treatments in higher stage cancers, but may be used in earlier stages, often to help prevent recurrence.

Chemotherapy

This is the use of anti-cancer drugs that can be delivered orally, intravenously, or even by spinal injection. These drugs can be aggressive, and potentially have a host of side effects (including menstrual changes and fertility issues), but have uses in many stages of cancer and significant effectiveness. The two main classes of chemo drugs are:

• Anthracyclines: These are chemically similar to antibiotics, and kill cancer cells by damaging their genetic material.
• Taxanes: These interfere with cancer cell division.

Chemo drugs are most often administered by IV, either by injection or infusion. They're usually given in cycles of 2-3 weeks, with rest periods in between, and administered over a course of 3-6 months. Chemotherapy can be indicated in the following situations:

• Adjuvant chemotherapy: Post-surgery chemo used to kill lingering or undetected cancer cells to lower the risk of recurrent cancer.
• Neoadjuvant chemotherapy: Pre-surgery chemo used to shrink tumors, especially in locally advanced cancers, so that they can be removed by surgery. Also reduces the risk of recurrent cancer.
• Advanced breast cancer: Chemo can be used to slow or stop the spread of cancer that has advanced beyond the breast and underarm.

Hormone Therapy

Some breast cancers have receptors, or proteins, that attach to estrogen, which spurs their growth. These estrogen-positive (ER-positive) and progesterone-positive (PR-positive) cancers, which account for about 2 out of 3 breast cancers, are affected by drugs that lower estrogen levels.

Hormone therapy drugs are used for as much as 5 years, and can be used before surgery to slow cancer's spread or afterwards to prevent it from recurring. These drugs tend to work in one of two ways:

• Blocking Estrogen Receptors: This prevents estrogen from connecting to cancer cells and making them grow and divide.
• Lowering Estrogen Levels: A lack of estrogen can slow or stop some breast cancers from spreading, and prevent them from recurring. Aromatase inhibitors stop the enzyme aromatase, found in fat tissue, from producing estrogen. This can be used alone in post-menopausal women or in combination with ovarian suppression in younger women.

Ovarian Suppression is sometimes used alongside aromatase inhibitors, effectively mimicking a post-menopausal state in younger women. This can be done by:

• Oophorectomy: Surgical removal of the ovaries.
• Luteinizing hormone-releasing hormone (LHRH) analogs: Drugs that block the body from signaling the ovaries to make estrogen.
• Chemotherapy drugs: Some of which damage ovarian function in pre-menopausal women.

Targeted Therapy

Targeted drugs are designed to attack the elements in cancer cells that cause their uncontrolled growth. In contrast, chemotherapy drugs attack any fast-growing cells, which is one of the reasons they have so many potential side effects. Targeted drugs have become more specific with our increased knowledge of what causes cancer cells to spread.

These drugs may target:

• HER2-Positive Breast Cancer: 1 in 5 women with breast cancer have an excess of the HER2 protein in their cells, a growth-promoting protein that can cause aggressive cancers.
• Hormone-Receptor Positive Breast Cancers: The ER-positive and PR-positive breast cancers discussed above may also be treated with drugs that block proteins that aid cell division, which slows cancer growth.
• BRCA Gene Mutations: We discussed BRCA mutations and the associated, hereditary risk of cancer recently. These drugs block PARP proteins, which repair damaged DNA in cells, which can cause the death of BRCA-mutated cancer cells.

Treating Breast Cancer by Stages

Now that you've been introduced to all these forms of treatment, let's look at which ones are typically utilized in each stage.

Stage I: Primarily surgery, often paired with radiation therapy. Chemo or hormone therapy may be used as an adjuvant, or additional, treatment.

Stage II: Local therapies, starting with either breast-conserving surgery or a mastectomy. Treatment via BCS is paired with radiation therapy; this may also be the case with a mastectomy if cancer has spread to the lymph nodes. Systemic therapy is recommended, especially neoadjuvant treatments in the case of large tumors.

Stage III: Often neoadjuvant chemotherapy, possibly along with targeted drugs, is used to shrink the tumor so that surgery can be done. The size of the tumor afterwards determines whether to opt for BCS or a mastectomy. This is followed by radiation therapy, and sometimes adjuvant systemic treatments as well.

Stage IV: Systemic therapies are the primary treatments. As the cancer has spread beyond the local area or region, treatments that work through the whole body are necessary. These include chemotherapy drugs, targeted therapies, and hormone therapies.

Treating Specialized Breast Cancers

Above we discussed some rare forms of breast cancer that operated somewhat differently that more common cancers. These require, if not different treatments than most breast cancers, variations on main treatments.

Inflammatory Breast Cancer

This is an aggressive cancer that has spread at least to lymph vessels in the skin, and so is considered either a Stage III or IV cancer depending on its spread. Treatment is based on stage:
Stage III: Chemotherapy, possibly along with targeted therapy. This is followed by surgery to remove at least the tumor in the breast as well as the affected lymph nodes, as well as radiation. Additional systemic treatments often follow.

Stage IV: Systemic therapy, including chemotherapy, hormonal therapy, and targeted therapy.

Recurrent Breast Cancer

When cancer has returned after breast cancer treatment, the approach to the new instance depends on where the cancer has recurred.

Local Recurrence: Cancer has recurred in the same breast or surgery scar. This is usually treated in one of two ways, dependent on the original treatment:

• If BCS was opted for originally, a full mastectomy may be performed.
• If a mastectomy was used originally, the new tumor is removed and radiation therapy is performed.

Regional Recurrence: Cancer has recurred in the lymph nodes near the site of the original breast cancer. These lymph nodes are removed and radiation is aimed at the area. Post-surgery, systemic treatment may be considered.

Distant Recurrence: Cancer has recurred anywhere in the body. This is treated in much the same way as Stage IV breast cancer is treated when cancer is found in distant areas, and can encompass both local and systemic therapies.

Triple-negative breast cancer

As these cancers do not have estrogen or progesterone receptors or an excess of the HER2 protein, targeted and hormone therapies are not viable. Chemotherapy is usually the primary treatment.

The many types of cancer and numerous options available to fight them seem overwhelming, and these options themselves are intimidating. Many of them are invasive or have uncomfortable side effects. It can be easy to be distressed by these treatments even when you have a lower stage cancer with a good prognosis; cancer treatment always requires a great deal of effort on the part of the patient. But although the treatments can be intense, everyone reacts to them differently. Many people have few side effects. And no matter how you respond to treatment, there are always support options: medical professionals, counselors, and support groups composed of other patients and survivors. No matter how tough it is to fight breast cancer, no one has to go it alone.